We present a large outbreak of ESBL-producing Klebsiella pneumoniae in a neonatal intensive care unit that resulted in 31 colonized infants, 10 invasive infections, and 5 attributable deaths over a 5-month period. Although the source of infection was unknown, overcrowding and understaffing appeared to have been aggravating factors.

We compared 2 data sources—antimicrobial orders and bar-coded medication administration (BCMA)—for calculating the number of grams used, grams used based on defined daily dose, and days of therapy at one Veterans Affairs Medical Center for 2009-2010. The number of grams used calculated from BCMA data provided the most informative antimicrobial utilization measure.

Little is known about postdischarge surveillance practices currently in place among American hospitals. This survey describes practices used by acute care hospitals covered by Washington State's legislated mandate for public reporting of surgical site infections. While the vast majority of facilities use multiple techniques, wide variation in practices was discovered.

Infect Control Hosp Epidemiol 2012;33(1):8

We conducted a retrospective cohort study to assess respiratory colonization before and after the use of chlorhexidine oral decontamination among a cohort of intensive care unit patients who received mechanical ventilation. We observed a decrease in the prevalence of Enterobacteriaceae and an increase in the incidence of fungal colonization. Chlorhexidine oral decontamination might have a differential effect on respiratory colonization.

We describe the prevalence of and risk factors for colonization with extended-spectrum (3-lactamase-producing Enterobacteriaceae (ESBL-EB) in the long-term care facility (LTCF) setting. Colonization prevalence differed significantly across the 3 LTCFs evaluated in the study, with recent use of levofloxacin and fecal incontinence demonstrating borderline significant associations with ESBL-EB colonization.

Infect Control Hosp Epidemiol 2012;33(3):302-304

This study was designed to test in vitro efficacy of 2 improved hydrogen peroxide (HP) products against 3 standard HP products and 1 quaternary ammonium compound. Improved HP is significantly superior to standard HP at the same concentration and can be used for disinfection of environmental surfaces or noncritical patient care items.

A multicenter survey of 11 cancer centers was performed to determine the rate of hospital-onset Clostridium difficile infection (HO-CDI) and surveillance practices. Pooled rates of HO-CDI in patients with cancer were twice the rates reported for all US patients (15.8 vs 7.4 per 10,000 patient-days). Rates were elevated regardless of diagnostic test used.

Clinical decision support systems (CDSSs) for antimicrobial stewardship require considerable human resources and financial investments. This pre-/postimplementation study evaluated the effect of a CDSS on performance of prospective audit with intervention and feedback and demonstrated an increase in interventions and recommendation acceptance countered by a substantial number of non-actionable alerts.

We used mandatory public reporting as an impetus to perform a statewide study to define risk factors for surgical site infection. Among women who underwent abdominal hysterectomy, blood transfusion was a significant risk factor for surgical site infection in patients who experienced blood loss of less than 500 mL.

Infect Control Hosp Epidemiol 2012;33(1):90-93

Automated surveillance using electronically available data has been found to be accurate and save time. An automated Clostridium difficile infection (CDI) surveillance algorithm was validated at 4 Centers for Disease Control and Prevention Epicenter hospitals. Electronic surveillance was highly sensitive, specific, and showed good to excellent agreement for hospital-onset; community-onset, study facility-associated; indeterminate; and recurrent CDI.

Infect Control Hosp Epidemiol 2012;33(3):305-308